Relationship between diabetic retinopathy and diabetic nephropathy; A longitudinal follow-up study from a tertiary care unit of Karachi, Pakistan.

OBJECTIVE: To determine the development and progression of diabetic retinopathy in subjects with diabetic nephropathy. METHODOLOGY: This retrospective longitudinal follow up study was conducted in outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes unit of Karachi Pakistan, from January 2005 to December 2016. Type 2 diabetic subjects with newly diagnosed diabetic nephropathy (DN) and sex-age matched controls were identified from the electronic database of the institute, Health Management System (HMS). Subjects with type 1 diabetes, gestational diabetes and subjects with diabetic retinopathy (DR) at the baseline of both DN and non-DN group were excluded from the study. Statistical analyses were conducted by using SPSS version 20. RESULT: Out of 3056 type 2 diabetic subjects, 2389 were with DN and 667 were without DN. The incidence of retinopathy was found to be 21.7 per 1000 person years. The incidence rate ratio (IRR) of 2.57 (1.92-3.43) showed that retinopathy was significantly higher in subjects with DN as compared to subjects without DN. Kaplan-Meier survival plot confirmed that subjects with DN had a worse diabetic retinopathy-free survival than subjects without DN. CONCLUSION: Diabetic nephropathy is an independent risk factor for the development and progression of diabetic retinopathy.

Frequency and risk of metabolic syndrome in prediabetics versus normal glucose tolerant subjects -- a comparative study.

OBJECTIVE: To compare the frequency and risk of metabolic syndrome in pre-diabetics against normal glucose-tolerant subjects attending diabetes screening camps in an urban centre. METHODS: The cross-sectional study was carried out at the Jinnah Postgraduate Medical Centre, Karachi, from January to August, 2008, and comprised subjects recruited through diabetes screening camps. They were >30 years of age, without prior history of diabetes and were screened through fasting plasma glucose and 2-hour oral glucose tolerance test. Demographic, anthropometric, clinical and biochemical measurements were done. Frequency of different components and their constellation as metabolic syndrome were determined according to the Adult Treatment Panel-III criteria. Relative risk was estimated to find the risk of metabolic syndrome in pre-diabetics versus normal glucose-tolerant subjects. RESULTS: The study sample comprised 80 subjects; 40(50%) normal glucose-tolerant in Group A and 40(50%) pre-diabetics in Group B. In Group A, there were 25(62.5%) men and 15(37.5%) women, while Group B had 22(55%) men and 18(45%) women. The mean age in Group A was 38.08±5.35 years, while in Group B it was 39.09±6.12 years. The frequency of various cardiovascular risk factors was higher in pre-diabetics (p< 0.05). Central obesity was the most prevalent risk factor (85%, CI: 75.74-96.06), followed by low levels of high density lipoprotein (82.5%, CI: 72.64-94.27), raised triglycerides (67.5%, CI: 55.35-82.01), hypertension (57.5%, CI: 44.68-72.82), and fasting plasma glucose >100mg/dl (42.5%, CI: 29.68-57.82). Metabolic syndrome was found in 23(57.5%) in Group B compared to 9(22.5%) Group B, according to Adult Treatment Panel-III criteria. Calculated relative risk indicated that Group B was 1.9 times more prone to be suffering from metabolic syndrome compared to Group A. CONCLUSIONS: Pre-diabetics were more prone to developing cardiovascular disorders than normal glucose-tolerant subjects.